The President's Plan To Fix The Senate Health Bill

By Big Tent Democrat, Section Obama Administration
Posted on Mon Feb 22, 2010 at 10:05:16 AM EST
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Via Ezra Klein (PDF):

Key changes include:

• Eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid;
• Closing the Medicare prescription drug “donut hole” coverage gap;
• Strengthening the Senate bill’s provisions that make insurance affordable for individuals and families;
• Strengthening the provisions to fight fraud, waste, and abuse in Medicare and Medicaid;
• Increasing the threshold for the excise tax on the most expensive health plans from $23,000 for a family plan to $27,500 and starting it in 2018 for all plans;
• Improving insurance protections for consumers and creating a new Health Insurance Rate Authority to provide Federal assistance and oversight to States in conducting reviews of unreasonable rate increases and other unfair practices of insurance plans.

(Emphasis supplied.) [More...]

The last proposal can not be passed through reconciliation without a waiver of the Byrd Rule. I suppose it will be put to a vote to see if Republicans dare defend Anthem-like rate increases. Obviously, the headlines are the excise tax fix - which is pretty good imo, and no public option.

The public option is not Obama's baby, though I doubt he'll stand in its way if the votes can be mustered for it. He won't be doing any of the mustering obviously.

Speaking for me only

< Sunday Night Open Thread | Some Key Points in President Obama's Health Care Proposal >

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The President's Plan To Fix The Senate Health Bill | 40 comments (40 topical)

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This is a plan to have a plan, not a plan (5.00 / 3) (#24)
by lambert on Mon Feb 22, 2010 at 11:47:54 AM EST

We've got twelve pages of bullet points, and no detail, and everybody knows that's where the devil is (and the loopholes are). HR676 is a complete law, and it's only 37 pages.

After a year, this is what we get?

: This Is Not A Plan (5.00 / 1) (#35)
by norris morris on Mon Feb 22, 2010 at 09:46:56 PM EST

It's totally lacking in details, and the Devil is in the details.
So from these bullet points about legislation that is over 2000 pages long, we are to GUESS
what this bill contains?
I cannot imagine how stupid we appear as we struggle to understand it's specifics and oh yes, Obama can't bear to even mention the public option.
Obama either cannot articulate what he wants to see in this bill, or he may just not be able to communicate on this level.
This condensed explanation and declaration doesn't go far enough.
These are rough ideas that have been interpreted over and over and have created confusion about its meanings. This kind of vagueness allows the Republicans to explain it for Obama, and that's a loser as we all know.
Obama seems to have problems communicating a cohesive and detailed bill and it's execution.
Mind you we don't even know how many years we'll have to wait for any of the proposed benefits to kick in,or if some of them take place ASAP. But ASAP has not emerged from this WHouse so far.

Why not a transactions tax? (5.00 / 1) (#26)
by lambert on Mon Feb 22, 2010 at 12:05:30 PM EST

A much better approach than a dividends tax. Yields are greater, and it's a disincentive for speculation.

National exchange also not in the proposal (none / 0) (#1)
by Big Tent Democrat on Mon Feb 22, 2010 at 10:10:10 AM EST

Perhaps getting it done through reconciliation was too troublesome, but more likely, not the 50 votes for it in the Senate.

The lack of a national exchange (none / 0) (#2)
by andgarden on Mon Feb 22, 2010 at 10:12:23 AM EST

guarantees what was already likely with one: regulation will be impossible and toothless.


National exchange wouldnot have provided (none / 0) (#3)
by Big Tent Democrat on Mon Feb 22, 2010 at 10:17:56 AM EST

regulation either.

It's not really a mechanism for that.


It would have been marginally less complicated (none / 0) (#4)
by andgarden on Mon Feb 22, 2010 at 10:18:55 AM EST

In theory (none / 0) (#8)
by Big Tent Democrat on Mon Feb 22, 2010 at 10:23:43 AM EST

the OFM was to review all plans on the exchanges, state of federal.

Personally, I doubt that can be true.


How long to you think (none / 0) (#10)
by andgarden on Mon Feb 22, 2010 at 10:24:54 AM EST

the rulemaking to arrive at a procedure for that will take? 15 years?


Heh (none / 0) (#15)
by Big Tent Democrat on Mon Feb 22, 2010 at 10:37:27 AM EST

Of course the other problem is the ENFORCING of the rules made.


Ought to be fun under a Republican President (none / 0) (#17)
by andgarden on Mon Feb 22, 2010 at 10:40:11 AM EST

: You mean like we have now? (5.00 / 2) (#25)
by lambert on Mon Feb 22, 2010 at 11:49:53 AM EST

[rimshot, laughter]
Senator Kennedy, who advocated progressively lowering the age of Medicare eligibility as road to Medicare for All, must be spinning in his grave. Sad.

I prefer the State Exchange (none / 0) (#37)
by s5 on Tue Feb 23, 2010 at 12:33:17 AM EST

Two reasons:

A state exchange gives us the less-evil Nelson abortion language instead of Stupak.
A state exchange makes it easier for states like California to pass a single payer bill, and get it funded through the federal money that's been allocated.

I won't trade either of those for the marginal benefits of a national exchange. Obama made the right call.


He makes a reference to (none / 0) (#11)
by Anne on Mon Feb 22, 2010 at 10:25:42 AM EST

"when the exchanges begin in 2014" in the "Extend Consumer Protections against Health Insurer Practices" section of the proposal, but I don't see any other discussion of these exchanges, unless I'm not looking in the right place for it.


No discussion is the point (none / 0) (#13)
by Big Tent Democrat on Mon Feb 22, 2010 at 10:26:30 AM EST

He is sticking to the Senate plan on this issue.


: No Discussion Is The Point (none / 0) (#36)
by norris morris on Mon Feb 22, 2010 at 09:58:14 PM EST

It makes it easier to dodge explaining with clarity.
It makes it easier to dodge explaining the details Obama hasn't been able to do, or that he prefers not to.
The Senate bill is a landmine with NelsonBombs strewn among the remains and some other beauts we have never been informed of.
Where's the leadership? This is so amateurish
it's disturbing.

BTW, look at table 1 on page 4 (none / 0) (#5)
by andgarden on Mon Feb 22, 2010 at 10:19:52 AM EST

Am I reading this correctly, or is the WH plan making insurance more expensive for low income families than either original bill?

Looked that way to me, too. (none / 0) (#14)
by Anne on Mon Feb 22, 2010 at 10:33:49 AM EST

ANd even though David Dayen at FDL says this:

Affordability. The subsidies improve upon the Senate bill, particularly at the low end, but also between 250-400% of poverty, where the maximum amount of income paid out of pocket as in insurance premium dips from 9.8% to 9.5%. The actuarial value also increases at the low end slightly, from 133% to 250% of poverty. For instance, instead of a 70% actuarial value at 250% of poverty, the number rises to 73%. These are cosmetic but tangible changes upward from the Senate bill.

it still looks to me like he is proposing that the lower end of the income spectrum pay more than what the House or Senate bills proposed; for reasons I do not understand, the percentage of contribution only drops at income levels above $55,000.


Soak the poor (none / 0) (#16)
by andgarden on Mon Feb 22, 2010 at 10:38:30 AM EST

Spreading the cost (none / 0) (#27)
by christinep on Mon Feb 22, 2010 at 01:03:58 PM EST

It does appear that the proposed cost adjustment for those under @33k is @350 upward. The cost for those between @65k to mid 80k is adjusted downward. What seems to have changed in the dollars subsidy (or, newly-called, middle-class tax relief) is a reconfiguration of those subsidies. Also: The proposal would up the Medicare payroll tax for those over 200k to make up for the adjustment & delay on excise tax. ('Sort of looks like the final stages of a $$ total amount negotiation--not unusual.)


: Addendum (none / 0) (#28)
by christinep on Mon Feb 22, 2010 at 01:07:35 PM EST

Tho I've never been very good at math, it does seem that the corresponding dollar amounts and changes relate to percentages. Whether it is economist driven or a political policy consideration, I'm guessing the goal is to keep the costs to the citizens at 10% or under.

Jane Hamsher finds (none / 0) (#31)
by jbindc on Mon Feb 22, 2010 at 02:04:14 PM EST

that the proposed mandatory penalty is also increased from 2% to 2.5%.

And, as Jane points out, Stu Rothenberg also just shifted 28 seats in the "R" direction for 2010.


How many family plans will cost (none / 0) (#6)
by observed on Mon Feb 22, 2010 at 10:20:22 AM EST

27,500 by 2018? Answer: as many as the insurance companies want.
What's the change in funding? Items 1-3 sound costly to me.

: Funding questions NOT answered (none / 0) (#7)
by Big Tent Democrat on Mon Feb 22, 2010 at 10:22:48 AM EST

as far as I can tell.
A key question.

The change in the (none / 0) (#9)
by Andy08 on Mon Feb 22, 2010 at 10:24:27 AM EST

excise tax threshold is a distraction and will be irrelevant in 2018 dollars. It will still affect a lot of working people/families unfairly. No game changer there imo.

I disagree (5.00 / 1) (#12)
by Big Tent Democrat on Mon Feb 22, 2010 at 10:25:50 AM EST

that it is meaningless.

Is it perfect? No. But it is a significant change.


The fact that he gives unions until 2018 (5.00 / 2) (#18)
by cawaltz on Mon Feb 22, 2010 at 10:56:03 AM EST

to hash out the differences between the cost of their health care plan and a wage increase might help union folk but it does little to the individuals or families who do not have the power of collective bargaining. I think the changes in amount seem less relevant without some sort of formulation that tells us why he picked this amount. I could easily see insurance premiums rising past that number in 8 years. Last year it rose 5.5, the year before that 4.4, 6 percent respectively the two years before that. Unless he has a mechanism in place to control costs $4,500 may be a drop in the bucket 8 years down the road.
Particularly, when I don't see any written in stone major mechanism to control costs.


: the largest insurer in Iowa (none / 0) (#39)
by desmoinesdem on Tue Feb 23, 2010 at 06:43:59 AM EST

is jacking up rates on its individual policy-holders from 15 percent to 25 percent this year. I have friends who now pay double the cost of their mortgage in health insurance premiums.
I agree with you--by 2018 tons of policies will have premiums high enough to be subject to the excise tax.

Agree to disagree... (none / 0) (#19)
by Andy08 on Mon Feb 22, 2010 at 10:57:35 AM EST

In my opinion, it is cosmetic. The change in threshold is designed to placate some people who look at their costs "today". But it's an illusion. Unions will go along b/c they believe that there is enough time (until 2018) to strike this down. But it won't happen and the unfairness of the excise tax remains.
Despite guarantees that the thresholds will be raised if living costs do the new tax will be there for a lot of working people anyway.

Now the new fees on Pfizer are more honest and more interesting.

Bloomberg
Obama Endorses New Medicare Tax, More Drugmaker Fees (Update1)


: If not strike it down (none / 0) (#20)
by cawaltz on Mon Feb 22, 2010 at 11:04:54 AM EST

It would perhaps give them a chance to insist that some of the money employers are using towards health care be converted to income. Of course, most of the folks in union households know that it isn't going to be the dream 1:1 ratio the villagers insist is going to happen. As it was the company my husband worked for wanted them to take a lower pay level and offered to pay the kit and kaboodle on health costs. I guess they figured they could recoup the money in tax breaks.

Other tweaks to the excise plan that are more than (none / 0) (#21)
by steviez314 on Mon Feb 22, 2010 at 11:15:42 AM EST

minor:

Exclusion of vision and dental as taxable.

Adjustment of plan cost as it applies to the threshold for age and gender of the workers.

I assume that both of these reduce the number of union plans that would be taxable.


: If you make numbers those (none / 0) (#40)
by Andy08 on Tue Feb 23, 2010 at 03:41:42 PM EST

exclusions are still quite minor! And the "adjustment" will always lag behind the cost of the premiums so as I said, the tax will continuously be paid by workers.
To those who insist any of this money will go back to workers in the form of salaries increases I have a bridge to sell.

The HIRA (none / 0) (#22)
by robotalk on Mon Feb 22, 2010 at 11:32:45 AM EST

if effective, will only be effective based on what kind of admin is in power. No antitrust revisions. Not even a national exchange.

I think this pretty weak tea, as usual, from Obama.

I'm still trying to figure out his strategy (none / 0) (#23)
by cawaltz on Mon Feb 22, 2010 at 11:35:34 AM EST

for actually keeping costs down. If he was looking to decouple insurance from employment then offering tax breaks to small employers doesn't seem to accomplish that........

He talks about simplified papers and forms bu he doesn't really talk about any regulation that forces the usage or acceptance of these forms....

It isn't a total bust though if he can get stuff like the full disclosure of administrative costs and salaries versus money spent on care disclosed by providers.

I like that My kids will be covered until 26.

I like that preventive care and immunizations will be free.

I also agree that for the most part he sticks to plain English. Although I am still trying to figure out his formula for what employers will pay into health care coverage.

Strategy for cost containment (none / 0) (#29)
by christinep on Mon Feb 22, 2010 at 01:15:50 PM EST

Normally, federal legislation is filled in with the regulatory details which ultimately follow. In general, tho, the theory starts with increasing the pool--i.e., more customers for the companies should translate to less costs creep. When the "should" doesn't pan out, the proposal would require HHS to set up a system for establishing guidelines and enforcement regarding rate hikes. (As to the latter: Ed Schultz suggested this am that it is reminiscent of a public utility commission process, whereby rates are contained by the commission.)


: Almost forgot (none / 0) (#30)
by christinep on Mon Feb 22, 2010 at 01:17:52 PM EST

Re: preventive health care--which you reference--is usually associated with a partial strategy for overall cost containment as well. (The old "stitch in time saves nine" as it were.)

This is (none / 0) (#32)
by Ga6thDem on Mon Feb 22, 2010 at 02:42:07 PM EST

a sick joke. I can't believe the WH rehashed and rewarmed the Senate Plan to hand out. They really think we're all a bunch of idiots don't theny?

Is this just Obama's way of (none / 0) (#33)
by observed on Mon Feb 22, 2010 at 05:07:09 PM EST

ruling out the PO?
Maybe the bullet points in the plan aren't what matter.
Let's see if any more Senators sign the pro-PO letter.

The Rate Authority is a slide-step ... (none / 0) (#34)
by RonK Seattle on Mon Feb 22, 2010 at 08:52:31 PM EST

... toward federalized regulation of health insurance.

This will be attractive to Republicans, who will project it as a step toward selling insurance across state lines.

This will be attractive to the insurance industry, who will project it as a step toward regulatory capture on a grand, efficient scale.

This will be attractive to Democrats, who will project it as an enforcement mechanism against recognized vices of the insurance industry.

not to refight... (none / 0) (#38)
by markw on Tue Feb 23, 2010 at 05:19:17 AM EST

Not to refight the primary wars, but I remember when another Democratic candidate for President promised that, if she were elected, we would have "universal health care coverage by the end of my second term" -- and much of the netroots ridiculed that as going too slow and supposedly indicative of a sell-out do-nothing approach.